HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11\\\I <� Permit Number: \0\1C>CN'zi3Va
RECEIVED
� Building Permit Application SEP 182019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address:
(Property Tax ID #:
,Site Plan Name:
Project Name: _
5 1104-11r► &% b [
61- �13-()i-,I.a-00o-'7
Lot No. (57
Block No. l
CON ITI
CTfON INFORMATION:
Additional work to be performed under this permit —,check all that apply:
_Mechanical Gas`Ta'nk ` ' _Gas Piping —Shutters ' Windows/Doors
Electric Plumbing _Sprinklers _ Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction,:- Utilities: _ Sewer _ Septic Building Height:
OWNER/I_ExSS E:
CONTRACT• R:
Name iCA(/ti'1
Name: h :.
Add res : (0 C
C I i
Company: k
City: State: fL
Zip Coder Fax: i
Phone No.
Address: oZN
City: Stater
Zip Code: yy�� Fax:
Phone No .? :— 626- (P�Y0
E-Mail fbAU ffn An � �Z'J�lI . C64-M
State or County License
E-Mail:
Fill in fee.simple Title Holder on next page ( if different
from'the.Owner listed above)
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Addre!
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
State
Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORID
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COUNTY OF ( r
COUNTY OF .
The f ng ins u get w s acl owledge¢-before me
this day 20� by
The f g instru e t as owledge 3wfore me
thisday o 20_ by
�u,�, � I�ard'-ran
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification 7
Personally Known OR Produced Identification
Type of I ification
Type of (dent 'cation
/ v
duce
Produ
(Si a e of Not Public-Sta f FI rid ®s4 JO a•••
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(S' a re of ary Public- to of I rmera Ole
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Commission No. / `
Commission No CeIT/
:MY Comm-Expi
January
5, 2023
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1.0�;�`�
DATE
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Rev. 2/7/ 19